Skip to main content

Advertisement

SpringerLink
Log in

Successful treatment of multiple Pseudallescheria boydii brain abscesses and ventriculitis/ependymitis in a 2-year-old child after a near-drowning episode

  • Case Report
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Rationale

We report on a cerebral infection by Pseudallescheria boydii in a 21-month-old boy after a near-drowning episode. MRI revealed multiple (>60) intracerebral abscesses.

Methods

The surgical therapy included CSF drainage and microsurgical resection of one abscess for microbiological diagnosis. Antimycotic therapy included terbinafine and intraventricular caspofungin in addition to voriconazole.

Results

Systemic side effects of chemotherapy were not observed. After placement of a ventriculoperitoneal shunt, the boy was transferred to a rehabilitation clinic and improved neurologically. After 20 months, MRI documented a continuing remission of the disease.

Conclusion

Our case proves that an aggressive treatment should be undertaken and can be successful in CNS pseudallescheriasis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Anderson RL, Carroll TF, Harvey JT, Myers MG (1984) Petriellidium (Allescheria) boydii orbital and brain abscess treated with intravenous miconazole. Am J Ophthalmol 97:771–775

    CAS  PubMed  Google Scholar 

  2. Cornely OA, Schmitz K, Aisenbrey S (2002) The first echinocandin: caspofungin. Mycoses 45(Suppl 3):6–60

    Google Scholar 

  3. Dworzack DL, Clark RB, Borkowski WJ Jr, Smith DL, Dykstra M, Pugsley MP, Horowitz EA, Connolly TL, McKinney DL, Hostetler MK (1989) Pseudallescheria boydii brain abscess: association with near-drowning and efficacy of high-dose, prolonged miconazole therapy in patients with multiple abscesses. Medicine (Baltimore) 68:218–224

    CAS  Google Scholar 

  4. Fisher JF, Shadomy S, Teabeaut JR, Woodward J, Michaels GE, Newman MA, White E, Cook P, Seagraves A, Yaghmai F, Rissing JP (1982) Near-drowning complicated by brain abscess due to Petriellidium boydii. Arch Neurol 39:511–513

    CAS  PubMed  Google Scholar 

  5. Garcia JA, Ingram CW, Granger D (1990) Persistent neutrophilic meningitis due to Pseudallescheria boydii [letter]. Rev Infect Dis 12:959–960

    CAS  PubMed  Google Scholar 

  6. Girmenia C, Luzi G, Monaco Mmartino P (1998) Use of voriconazole in treatment of Scedosporium apiospermum infection: case report. J Clin Microbiol 36:1436–1438

    CAS  PubMed  Google Scholar 

  7. Kershaw P, Freeman R, Templeton D, DeGirolami PC, DeGirolami U, Tarsy D, Hoffmann S, Eliopoulos G, Karchmer AW (1990) Pseudallescheria boydii infection of the central nervous system. Arch Neurol 47:468–472

    CAS  PubMed  Google Scholar 

  8. Meletiadis J, Mouton JW, Rodriguez-Tudela JL, Meis JF, Verweij PE (2000) In vitro interaction of terbinafine with itraconazole against clinical isolates of Scedosporium prolificans. Antimicrob Agents Chemother 44:470–472

    Article  CAS  PubMed  Google Scholar 

  9. Nesky MA, McDougal EC, Peacock JE Jr (2000) Pseudallescheria boydii brain abscess successfully treated with voriconazole and surgical drainage: case report and literature review of central nervous system pseudallescheriasis. Clin Infect Dis 31:673–677

    Article  CAS  PubMed  Google Scholar 

  10. Pacetti SA, Gelone SP (2003) Caspofungin acetate for treatment of invasive fungal infections. Ann Pharmacother 37:90–98

    Article  CAS  PubMed  Google Scholar 

  11. Pérez RE, Smith M, McClendon J, Kim J, Eugenio N (1988) Pseudallescheria boydii brain abscess: complication of an intravenous catheter. Am J Med 84:359–362

    Article  PubMed  Google Scholar 

  12. Pfaller MA, Marco F, Messer SA, Jones RN (1998) In vitro activity of two echinocanin derivatives, LY303366 and MK-0991 (L-743,792), against clinical isolates of Aspergillus, Fusarium, Rhizopus, and other filamentous fungi. Diagn Microbiol Infect Dis 30:251–255

    Article  CAS  PubMed  Google Scholar 

  13. Ryder NS (1999) Activity of terbinafine against serious fungal pathogens. Mycoses 42:115–119

    CAS  PubMed  Google Scholar 

  14. Rüchel R, Wilichowski E (1995) Cerebral Pseudallescheria mycosis after near-drowning. Mycoses 38:473–475

    PubMed  Google Scholar 

  15. Safdar A, Papadopoulos EB, Young JW (2002) Breakthrough Scedosporium apiospermum (Pseudallescheria boydii) brain abscess during therapy for invasive pulmonary aspergillosis following high-risk allogeneic hematopoietic stem cell transplantation. Scedosporiosis and recent advances in antifungal therapy. Transplant Infect Dis 4:212–217

    CAS  Google Scholar 

  16. Sheehan DJ, Hitchcock CA, Sibley CM (1999) Current and emerging azole antifungal agents. Clin Microbiol Rev 12:40–79

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors wish to thank Professor R. Rüchel, Universität Göttingen, Germany, and Professor K. Tintelnot, Robert-Koch Institute Berlin, Germany, for their helpful comments during the discussion of therapeutic options.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Zentralklinik, Robert-Koch Allee 9, 99438, Bad Berka, Germany

    Kay Mursch, Svorad Trnovec & Julianne Behnke-Mursch

  2. Department of Microbiology, Zentralklinik, Bad Berka, Germany

    Heinrich Ratz

  3. Department of Anaesthesiology and Intensive Care Medicine, Zentralklinik, Bad Berka, Germany

    Detlef Hammer

  4. Institute for Medical Microbiology and Immunology, Universität Bonn, Bonn, Germany

    Regine Horré

  5. Clinic for Child and Juvenile Medicine, Klinikum Chemnitz, Chemnitz, Germany

    Albrecht Klinghammer

  6. Centraalbureau voor Schimmelcultures, Utrecht, The Netherlands

    Sybren de Hoog

Authors
  1. Kay Mursch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Svorad Trnovec
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Heinrich Ratz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Detlef Hammer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Regine Horré
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Albrecht Klinghammer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sybren de Hoog
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Julianne Behnke-Mursch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julianne Behnke-Mursch.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mursch, K., Trnovec, S., Ratz, H. et al. Successful treatment of multiple Pseudallescheria boydii brain abscesses and ventriculitis/ependymitis in a 2-year-old child after a near-drowning episode. Childs Nerv Syst 22, 189–192 (2006). https://doi.org/10.1007/s00381-005-1151-3

Download citation

  • Received:

  • Revised:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-005-1151-3

Keywords

Search

Navigation